I have a long drama about BCG & PPD which some out there may benefit from; especially foreign nurses moving to the US.
I had BCG as a child (age 2 I think) in preparation for my parents to move to South America. I was told to never accept a PPD because I would react.
At the age of 21 as a new nurse they gave me a PPD anyway and surprise surprise it was postive. I had to have a CXR then no more PPD's while I worked at that facility.
The next couple of jobs I took they took my word that I was reactive and that it was due to the BCG and sometimes I would have to have a CXR and sometimes they just looked at my previous reports and left well enough alone. I also thought it was ironic because I thought I was one of the few Americans out there actually protected against TB yet I was always under intense scrutiny.
I changed jobs in 2002 and my new facility took a CXR report I had from the year before (different places intermittently would decide I needed one) and that was good enough then and the next year. In 2004 they decided I needed a PPD; whatever, I though it was silly and I would react but I'm not afraid of needles. They assured me BCG would only cause a reaction for 15-20 years and I was way past that window. My PPD was negative that year! (2004). So I go back the next year and hold out my arm. That stupid thing started burning and itching hours after I left employee health and I had a nice sized red lump 72hrs later. I was assured when I was being checked by the nurse that this was a reaction to the preservative (nickel) and that the bump didn't have margins (which I disagreed with) so I was negative; see you next year !!
I should have gotten my doctor to see this bump so he could write a note saying I was "allergic" and shouldn't have another PPD but I heard rumors that our employee health wouldn't accept this (that's wrong but irrelevent now). I went in several days ago to have my annual TB test and let the nurse there know about the reaction and was there anything I could do. She stated she would need a note from my doctor then I could be exempt but obviously he would need to see a reaction to write the note so hold out your arm please. Then she saw my record and my history. "You should have had a CXR last year if you had redness", "Why didn't an RN read your PPD?" (like I'm questioning their procedures!). Apparently RN's, LVN's and techs read them there and it's considered fine but suspicious looking ones should be checked by an experienced nurse. She gave me the PPD and the name of the nurse who should check me today (knowing it would most likely react again).
Today the experienced RN checked my arm and says oh yea, you're positive, 18mm reaction, not an allergic reaction, clear margins (just like last year's). She says the antibodies produced by the BCG are no longer effective against the disease after a few years but are floating around there kind of hiding out. It took me kind of getting sensitized again (by that first PPD in 2004) and then I reacted last year and again this year. I wasn't happy but at least THIS hospital won't try again to give me a PPD. It took 6 months for the mark to go away last year. No CXR needed but she almost sent me to the County Health department. That would have been an adventure since I work in a large urban area. She also explained about how the CDC had changed their policied about PPD's with people who had BCG back the mid 90's and I've kind of gotten caught in the middle.
Anyhow; we'll see what they say next year; the story seems to change every year. . .
